The deployment of enterprise-wide-solutions (EWSs) provided by vendors like Epic and Cerner poses a major threat to the future development of pathology and radiology informatics. The crux of the problem is that such EHR installation always move system control to the central IT departments and away from pathology and radiology. This is in contrast to the more than three decade history of pathology and radiology managing their own LISs, RISs, and PACSs. It turns out that that the radiology informaticians have been worrying about this problem in addition to the concern in pathology (see: Rethinking Radiology Informatics). A recent article voiced the concern of radiology informaticians about this turn of events and below is a quote from the article:
Radiologists are groundbreaking leaders in clinical information technology (IT), and often radiologists and imaging informaticists created, specified, and implemented these technologies, while also carrying the ongoing burdens of training, maintenance, support, and operation of these IT solutions. Being pioneers of clinical IT had advantages of local radiology control and radiology-centric products and services. As health care businesses become more clinically IT savvy, however, they are standardizing IT products and procedures across the enterprise, resulting in the loss of radiologists' local control and flexibility. Although this inevitable consequence may provide new opportunities in the long run, several questions arise.
Drs. Kohl, Dreyer, and Geis, the authors of this paper, emphasize the loss of "local control and flexibility" for radiology with the deployment of EHRs like Epic. With such enterprise wide solutions, the ordering and reporting of radiology procedures is transferred from the RIS to the EHR. In previous times, control of ordering and reporting rested with departmental systems. This problem is going to get even worse as vendors like Epic develop their departmental modules like Beaker and Radiant that completely replace the department-based LIS and RIS. This will result in only a minimal set of IT responsibilities for pathology and radiology informaticians.
There is no question that standardization is a major impetus on the part of hospital executives for choosing an enterprise-wide-solution. Another objective, one that is usually unstated, is the desire by hospital executives to exercise control over all clinical information. The downside of this need to control all hospital IT is the loss of the skill sets of pathology and radiology informaticians. Although the radiology article cited above lays out the current challenges to radiology informatics, I believe that it falls short in proposing solutions for the future for both it and pathology informatics.
My initial response to this problem was that pathology informaticians, when pressed by the EWS model, should cede control of basic lab IT functions to the hospital central IT group and concentrate on the more interesting and esoteric components of lab computing such as molecular diagnostics and cancer genomics. Unfortunately, the Epic EWS is architected with only a single huge database with inadequate tools to support analytics and research. I have therefore come to the conclusion that, in the long run, the only possible solution for pathology and radiology informaticians is to deploy and manage their own LISs, RISs, and PACSs in the cloud with a return to departmental control.
I want to thank Dr. Bob Miller from the pathology department at Johns Hopkins Medicine for calling the radiology article cited above to my attention.